High HIV/AIDS prevalence in the Sub Saharan Africa (SSA) region has resulted in large numbers of children affected by HIV/AIDS through HIV infection, HIV+ caregivers who are ill, and family deaths from HIV/AIDS-related illness. Research in a number of international settings indicates that children affected by HIV/AIDS are at increased risk for a range of mental health problems including depression, anxiety, and social withdrawal. Prevention-focused and family-based interventions have important public health applications in preventing mental health problems, including behavioral problems that may increase risk of HIV infection. Despite the promising potential of these interventions, few evidence-based programs exist to prevent or treat mental health problems in children affected by HIV/AIDS in SSA. The mental health needs of children in these low-resource settings often receive little attention as families struggle to address both immediate medical concerns as well as the subsequent economic and social consequences of HIV/AIDS. As access to HIV/AIDS testing and treatment becomes increasingly available, family-based preventive mental health programs hold promising potential for systematic integration into community-based, public health services provided to families affected by HIV/AIDS. This pilot study will provide critical preliminary data and refine a family-based preventive intervention to strengthen protective factors and prevent mental health problems among children whose families are affected by HIV/AIDS in post-genocide Rwanda. In Rwanda, the dual vectors of HIV/AIDS and a legacy of communal violence present a situation of compounded adversity common in SSA that threatens successful family functioning. The proposed mixed qualitative and quantitative methods approach will both identify locally- and culturally relevant protective processes and mental health problems, and incorporate culturally-appropriate practices into the development of a family-strengthening intervention for families affected by HIV/AIDS. Active participation and input from local clinicians, four Community Advisory Boards (CABs), and the Rwandan government will inform the pilot study and provide an immediate channel for dissemination of the intervention once it is evaluated and ready for broader use.
The specific aims of the pilot study are to: 1) Adapt a US-developed, family-focused, and strengths-based prevention program to the context of HIV/AIDS in post-genocide Rwanda;2) pilot test the intervention protocol within a small set of families to assess acceptability, feasibility and further refine an intervention manual;and 3) conduct a pilot feasibility study among 80 families in order to examine whether the intervention a) improves caregiver-child relationships using measures of family connectedness, good parenting and social support, and b) is associated with preventing mental health symptoms, reducing HIV risk behaviors and increasing functioning in children.

Public Health Relevance

The proposed study will build the evidence base on interventions to support children and families affected by HIV/AIDS and the aftereffects of communal violence in low-resource settings, and may be adapted to other forms of family adversity and to a range of care providers. The mixed methods research approach for selecting and/or adapting and implementing culturally-informed assessments and intervention models has the potential to contribute to culturally-relevant and sustainable intervention models of mental health services for children and families for a range of health problems beyond HIV/AIDS.